title: A microbiological evaluation of level of disinfection for flexible cystoscopes protected by disposable endosheaths.
abstract: BACKGROUND
  Flexible cystoscopy is used in urological outpatient departments for diagnostic cystoscopy of bladder cancer and requires a high-level disinfection between each patient. The purpose of this study was to make a microbiological post disinfection efficacy assessment of flexible cystoscopes (FC) using disposable sterile endosheaths.
  
  
  METHODS
  One hundred endosheaths underwent a leak-test for barrier integrity after cystoscopy. Microbiological samples from these cystoscopies were obtained; after removal of the endosheath, and after cleaning the scope with a detergent cloth, rinsing with tap water followed by 70% ethanol disinfection and subsequent drying. The number of colony forming units (cfu) from the samples was counted after 72 hours and then divided in three categories, Clean FC (<5 cfu/sample), Critical FC (5-50 cfu/sample) and High-risk FC (>50 cfu/sample). The result was compared with data of 10 years continuous control sampling recorded in the Copenhagen Clean-Endoscope Quality Control Database (CCQCD) and analyzed with a Chi-square test for homogeneity.
  
  
  RESULTS
  All 100 endosheaths passed the leak-test. All samples showed a Clean FC and low means of cfu. A query to the CCQCD, showed that 99.8% (1264/1267) of all FC with a built-in work-channel reprocessed in a WD were clean before use.
  
  
  CONCLUSIONS
  The reprocessing of FC using endosheaths, as preformed in this study, provides a patient-ready procedure. The results display a reprocessing procedure with low risk of pathogen transmission, high patient safety and a valid alternative to the recommended high-level disinfection procedure of FC. However, the general impression was that sheaths slightly reduced vision and resulted in some patient discomfort.
authors.affiliation: Department of Urology, Frederiksberg University Hospital, Frederiksberg, Denmark. Peter_Hjorth82@Hotmail.com.
authors.forename: Peter Hjorth
authors.initials: PH
authors.lastname: Jørgensen
authors.forename: Torsten
authors.initials: T
authors.lastname: Slotsbjerg
authors.forename: Henrik
authors.initials: H
authors.lastname: Westh
authors.forename: Vicki
authors.initials: V
authors.lastname: Buitenhuis
authors.forename: Gregers Gautier
authors.initials: GG
authors.lastname: Hermann
mesh_terms: D020684:Cystoscopes / Q000382:microbiology*; D004203:Disinfection / Q000295:instrumentation* / Q000379:methods*; D004209:Disposable Equipment / Q000382:microbiology*; D019544:Equipment Failure Analysis; D004869:Equipment Safety / Q000295:instrumentation*; D019064:Product Packaging / Q000295:instrumentation* / Q000379:methods